The prevalence of dyslipidemia in Chinese residents continues to increase, and the mortality rate of coronary heart disease increases rapidly. On October 24th, the “Guideline for Prevention and Treatment of Dyslipidemia in Chinese Adults (2016 Revised Edition)” was formally released in Beijing. The guidelines showed that the overall prevalence of dyslipidemia in Chinese adults was as high as 40.4%. Experts predict that if the prevention and control are not strengthened, with the continuous increase in serum cholesterol levels in the population, it will lead to an increase of approximately 9.2 million cardiovascular events in China during the period between 2010 and 2030.

It is reported that the new guidebook has made significant updates to the risk stratification of cardiovascular disease based on the national epidemiological data of long-term cohort studies and clinical evidence-based research, and puts forward stricter control targets for people at high risk of ischemic cardiovascular disease. . The Guide emphasizes the need to determine treatment measures based on individual risk of cardiovascular disease; emphasizes therapeutic lifestyle changes as the basic treatment for patients with dyslipidemia; and emphasizes the importance of long-term drug lipid-lowering therapy in patients with hypercholesterolemia and those at high risk.

Nearly a decade of rapid increase in death from coronary heart disease in residents

Coronary heart disease, stroke and peripheral arterial disease are the major cardiovascular diseases that cause death and disability in China. They are collectively referred to as atherosclerotic cardiovascular disease. Although its development is a long process, the first onset of atherosclerotic disease may have a high risk of death or disability.

Gao Runlin, academician of the Chinese Academy of Engineering and chief expert of the National Center for Cardiovascular Diseases, said that in the past decade, the deaths of residents of coronary heart disease have increased rapidly, and China is facing a double burden of disease, that is, strokes related to hypertension have not yet been effectively controlled and are associated with high cholesterol. Myocardial infarction is rapidly increasing again. The dyslipidemia is closely related to the increased incidence of cardiovascular disease in China. Lowering the low-density lipoprotein cholesterol or cholesterol in the blood can prevent the risk of death or disabling diseases such as coronary heart disease and stroke.

The guidelines show that according to the national survey in 2012, the overall prevalence of dyslipidemia in adults was as high as 40.4%, the prevalence of hypercholesterolemia was 4.9%, and the prevalence of hypertriglyceridemia was 13.1%. The prevalence of low-density lipoprotein cholesterol (HDL-C)emia was 33.9%.

Professor Zhao Dong, deputy director of the Beijing Institute of Cardiopulmonary and Vascular Diseases, Beijing Anzhen Hospital, Capital Medical University, points out that dyslipidemia, characterized by elevated LDL-C or cholesterol, is atherosclerosis. Important risk factors for cardiovascular disease; regardless of the drug or measure taken, as long as blood LDL cholesterol can be lowered, it can stabilize, delay or subside atherosclerotic lesions, and can significantly reduce these lethal disability. Incidence, disability, and mortality of the disease. In addition, other types of dyslipidemia, such as elevated triglycerides or decreased high-density lipoprotein cholesterol, are also associated with increased risk of atherosclerotic disease.

Gao Runlin said that for patients with dyslipidemia, the prevention and treatment work focuses on raising the awareness rate, treatment rate, and control rate of dyslipidemia. In recent years, despite the increase in awareness and treatment of adult patients with dyslipidemia in China, the control rate is still at a relatively low level, and prevention and treatment of dyslipidemia needs to be strengthened.

Regular blood lipid testing and healthy lifestyle are important preventive measures

Zhao Dong said that checking blood lipids and healthy lifestyle regularly is an important measure to prevent and treat cardiovascular diseases. A good lifestyle includes insisting on a healthy heart diet, regular exercise, staying away from tobacco and maintaining an ideal body weight. To detect dyslipidemia in a timely manner, it is recommended that blood lipids be detected annually in men over 40 years of age and postmenopausal women; blood lipids should be measured every 3-6 months in patients with atherosclerotic cardiovascular disease and their high-risk groups; for atherosclerosis Patients hospitalized with sclerosing cardiovascular disease should be tested for blood lipids on admission or within 24 hours of admission.

The guidelines suggest that diets and lifestyle improvements must be maintained regardless of whether or not medications are selected for lipid-lowering therapy. Recommended daily intake of cholesterol is less than 300mg, especially in patients with existing atherosclerotic cardiovascular disease or high-risk groups, intake of fat should not exceed 20% -30% of total energy. Hypertriglyceridemia should reduce the daily intake of fat as much as possible, and daily cooking oil should be less than 30g. For fat intake, foods rich in n-3 polyunsaturated fatty acids (such as deep-sea fish, fish oil, vegetable oil) should be preferred. It is recommended that daily intake of carbohydrates account for 50%-65% of total energy. The use of carbohydrates rich in dietary fiber and low glycemic index was chosen to replace saturated fatty acids, and the daily diet should contain 25-40 g of dietary fiber (7-13 g of which is water-soluble dietary fiber). The intake of carbohydrates is dominated by cereals, potatoes, and whole grains, and the added sugar intake should not exceed 10% of the total energy (a lower requirement for obesity and hypertriglyceridemia).

It is recommended that moderate-intensity metabolic exercise be performed for 30 minutes per week for 5-7 days. Those who have heart and cerebrovascular disease should exercise moderate exercise under the guidance of a doctor.

Call for people under 55 to pay attention to the risk of cardiovascular disease

Professor Chen Weiwei, director of the National Center for Prevention and Control of Cardiovascular Diseases and chief physician of Fuwai Hospital of the Chinese Academy of Medical Sciences, said that taking different intensity interventions based on the risk of atherosclerotic cardiovascular disease is the core strategy for prevention and treatment of dyslipidemia.

The guidelines suggest that risk assessments should be conducted according to the recommended procedure: People under 55 years of age should be concerned about the risk of cardiovascular disease. Based on the degree of risk of atherosclerotic cardiovascular disease in individuals, it is decided whether to start drug lipid-lowering therapy. The reduction of LDL-C levels is the primary target of prevention of atherosclerotic cardiovascular risk.

The target values ​​for lipid-lowering therapy need to be set: LDL-C <1.8 mmol/L in very high-risk patients; LDL-C <2.6 mmol/L in high-risk patients; LDL-C <3.4 mmol/L in middle- and low-risk patients; LDL-C If the baseline value is higher than the target value, LDL-C is reduced by at least 50%. In patients with very high risk of LDL-C baseline within the target value, LDL-C should still be reduced by about 30%.

Clinical adjustment of lipid standards, preferred statins lipid regulating drugs. It is advisable to use medium-strength statin at the beginning, and adjust the dosage appropriately according to individual lipid-regulating efficacy and tolerability. Statins should continue to be used for a long time after they have achieved the desired therapeutic effect, and if they can tolerate, they should be avoided.

It is reported that the "Guideline for Prevention and Treatment of Dyslipidemia in Chinese Adults (2016 Revised Edition)" was revised and updated on the basis of the 2007 edition of "Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults". The new guide is supported by the National Health and Family Planning Commission's Disease Prevention and Control Bureau, National Center for Cardiovascular Diseases, Cardiology Division of Chinese Medical Association, Diabetes Branch of Chinese Medical Association, Department of Endocrinology of Chinese Medical Association, and Laboratory Medicine of Chinese Medical Association. The committee formed a joint committee on the revision of blood lipids guidelines. Based on the recent progress in the epidemiological studies of cardiovascular disease in China and the large-scale randomized clinical trials of dyslipidemia, and referring to relevant research at home and abroad, the revised experts have repeatedly discussed and discussed the cards and completed revisions in 2016. And officially released and implemented.

(Liu Ying)

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